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Assess toxicity of the regimen, in terms of incidence and severity of treatment-emergent peripheral neuropathy and quality of life.

Determine the overall survival.

OUTLINE: This is a multicenter study.

Patients receive oral melphalan on days 1-4, bortezomib IV on days 1, 8, 15, and 22, and dexamethasone orally or IV on days 1, 2, 8, 9, 15, 16, 22, and 23. Treatment repeats every 4-6 weeks for up to 20 courses in the absence of disease progression or unacceptable toxicity.

Blood, urine, and bone marrow aspirates are collected at baseline and periodically after treatment to permit the correlation of clinical results with measured molecular events. A single baseline peripheral blood DNA sample is collected for future association studies linking disease onset, progression, and response to administered therapy with single nucleotide polymorphisms. Blood plasma and urine samples are evaluated for proteomic markers associated with disease progression and therapeutic response. Peripheral blood RNA samples are evaluated for transcriptional response to treatment of peripheral blood lymphocytes. Bone marrow aspirates are collected to extract plasma cells by flow cytometry for gene expression profiling.

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Must not meet the following diagnostic criteria for symptomatic* multiple myeloma:

Lytic lesions on skeletal survey

Plasmacytoma

Increase in bone marrow plasma cells ≥ 30% NOTE: *Patients who meet the International Myeloma Working Group definition of symptomatic multiple myeloma with symptoms attributable only to associated amyloidosis and who do not otherwise meet the criteria for diagnosis of smoldering myeloma are potentially eligible upon approval of the principal investigator.

If not previously treated, patient is either not a candidate for autologous stem cell transplantation (ASCT) or has declined the option of ASCT

Patients who have undergone prior ASCT and have subsequently progressed are eligible, provided other eligibility criteria are met

No secondary or familial amyloidosis

PATIENT CHARACTERISTICS:

ECOG performance status 0-3

Creatinine < 5 mg/dL

Bilirubin < 2.5 times upper limit of normal (ULN)

ALT and AST < 3 times ULN

Absolute neutrophil count ≥ 1,000/mm³

Platelet count ≥ 80,000/mm³

Not pregnant or nursing

Negative pregnancy test

Fertile patients must use effective contraception

Peripheral sensory neuropathy < grade 3

No myocardial infarction within the past 6 months

No New York Heart Association class III or IV heart failure

No uncontrolled angina

No severe uncontrolled ventricular arrhythmias

No EKG* evidence of acute ischemia or active conduction system abnormalities (not including 1st degree AV-block, Wenckebach type 2nd degree heart block, or left bundle branch block) NOTE: *Prior to study entry, any EKG screening abnormality must be documented by the investigator as not medically relevant; there is no lower limit of LVEF below which patients are excluded from participation

No hypersensitivity to bortezomib, boron, or any of the other agents utilized in this study

No diagnosis or treatment of another malignancy within the past 3 years, except completely resected basal cell or squamous cell carcinoma of the skin, an in situ malignancy, or low-risk prostate cancer after curative therapy